Background
- A series of three drift dives were conducted with a divemaster
- A buddy team made two dives when they resurfaced and checked their computers
- One computer locked after the second dive, later revealing the team had made two deco violations
- After the third dive, one diver began to exhibit a skin rash related to decompression sickness and called the DAN Emergency Hotline for medical assistance
Reported Incident
While on a dive trip a dive buddy team planned to do three dives per day over two consecutive days. Although experienced divers, they were guided by a divemaster on a series of drift dives with minimal stress. The first dive of the second day was 22 msw for 62 minutes, next dive was 20 msw for 60 minutes. Though there was a strong current, nothing seemed out of the ordinary until the team surfaced and one buddy’s computer shut down for 24 hours. The other computer did not register any violations.
The team decided to continue with the third dive after a two-hour surface interval, however one buddy stayed above 10 msw while the other descended to 28 msw. Both divers logged a bottom time of 50 minutes for the third dive.
Approximately two hours after returning to shore, the diver on the deeper profile noticed pain to light touch around the torso without discolorations. The diver decided to call DAN Emergency Hotline as a precaution and the medic team confirmed that based on what he described it was likely to be a symptom of skin decompression sickness (DCS). But by the time the diver called the hotline he was asymptomatic, and DAN recommended medical evaluation to ensure nothing was missed. Then in absence of any other findings, DAN also recommended to stay out of the water for 30 days.
The diver chose to cancel the dives planned for the rest of the trip based on the medic recommendations.
Review
Skin DCS symptoms do not always present with outward skin issues. Common symptoms of skin DCS include an itchy rash, marbled pattern on the skin, deep tissue tenderness (or manifestations of Lymphatic DCS, which includes a marginally indurated swelling of the skin, possibly associated with deep tissue tenderness. These manifestations typically appear on areas where we tend to accumulate bodily fat, like abdomen, lower back, buttocks, thighs, upper arms, breasts, less frequently on flanks and torso, but regardless of a high BMI.
Decompression models are not very effective in predicting outcomes of reverse profiles. Although this cannot be seen as a smoking gun, this is plausible explanation for this incident. such as this reported incident, it is likely to build the inert gas load in the body, putting the diver more at risk for decompression related illnesses.
Recommendations
Cutaneous manifestations of decompression illness (DCI) might present within minutes to several hours following a dive. The earlier the manifestations and the more dramatic, the more serious the decompression insult. When suspecting DCS, a physician should evaluate any skin manifestation, as there may be other subtle signs that could support or rule out a diagnosis of DCI. If the evaluating physician is not familiar with diving medicine, they can always consult with DAN 24/7. Not all forms of cutaneous DCS are necessarily associated with poor outcomes, but some will greatly benefit from an early diagnosis and treatment.
When diving, always follow the more conservative dive computer between you and your buddy. Become familiar with the warnings and alerts of your dive computer. Plan your dive and dive your plan.